diverticulitis

Diverticulitis: description

Diverticulitis is a condition in which protuberances in the large or small intestine become inflamed. These protuberances refer to physicians as diverticulum; in several diverticula one speaks of diverticulosis. Intestinal diverticula are not pathogenic in themselves and initially cause no symptoms. In 90 to 95 percent of cases, they occur in the descending branch of the colon, especially at the point where the intestine makes an S-shaped bend (sigmoid colon or sigmoid colon). However, disintegrating the diverticula may cause discomfort such as abdominal pain, fever, constipation and flatulence.

Doctors distinguish between different forms or stages of diverticulitis:

• In about 75 percent of cases, there is one acute uncomplicated diverticulitis in front. Although the diverticula can cause unpleasant discomfort, it does not lead to further complications and damage in the intestinal wall. Almost always a conservative diverticulitis therapy is possible – that is a treatment without surgery.
• At a acute complicated diverticulitis the inflamed protuberances cause further problems, e.g. Abscesses, fistulas, a bowel obstruction or a hole (perforation) in the intestinal wall. Then usually a diverticulitis operation is necessary to avoid serious health consequences.
• In people with one Chronic-recurrent diverticulitis The diverticula ignite again and again, so that it comes to permanent damage in the intestinal wall. The sufferers suffer from recurring pain, constipation and other symptoms.

Often, the inflammation is limited to the environment of individual diverticula (peridiverticulitis), but it can also spread to larger sections of the intestine (pericolitis).

diverticulosis

Diverticulosis is not dangerous in itself but may develop into diverticulitis. Read more in the article Diverticulosis.

Diverticulitis: symptoms

For more on the signs and symptoms of diverticulitis, see: Diverticulitis – Symptoms.

Diverticulitis: causes

Many patients with diverticulitis suffer from constipation, It is believed that a low-fiber diet promotes the development of diverticula. Fibers are mainly found in fruits, vegetables and whole grains – but significantly less in industrially produced white flour products such as bread and rolls, pizza, French fries and other highly processed foods. This thesis suggests that the proportion of people with diverticulitis has risen almost exponentially in the last 100 years – in the same way as the change in dietary habits.

Low-fiber diet makes the chair hard and firm. The internal pressure in the intestine is thus higher than when the stool is soft and supple. This pressure and the connective tissue, which is less elastic in old age, cause the mucous membrane of the intestine to bulge outward in some places: diverticula form.

Remains of stool residues in the diverticula, especially if the stool accumulates in constipation, the protuberances can ignite and it develops a diverticulitis. The inflammation can be limited to the diverticulum, but also spread to the surrounding intestine.

Diverticulitis: examinations and diagnosis

Important advice for the diagnosis of diverticulitis is given by the physician medical history (Anamnese). He asks the patient where exactly the pain is and how it feels. Other symptoms such as fever and constipation are important clues; as well as the question of whether such an event has occurred before. Some people know that they have diverticula in the gut or have already undergone diverticulitis. Not infrequently, the doctor also randomly detects diverticula as part of a colonoscopy.

Sometimes doctors can treat the inflammatory diverticulum as a hardened structure in the left lower abdomen Keys, Scanning may be painful in diverticulitis. A physical exam also requires the doctor to snap the anus with his finger to detect changes in the rectum (digital rectal exam).

In the blood test For example, diverticulitis often causes elevated levels of inflammation – for example, an increase in the number of white blood cells (leukocytes), an altered blood cell lowering rate (ESR), and an elevated C-reactive protein (CRP). An experienced examiner can also check the inflamed diverticulum Ultrasonic detect. By means of computed tomography (CT) or magnetic resonance imaging (MRI), however, diverticulitis can be displayed much more accurately.

Sometimes the diagnosis of diverticulitis is one X-ray photograph of the abdomen when standing: If a diverticulum breaks, free air can enter the abdomen, which accumulates under the diaphragm and is clearly visible on the x-ray.

Diverticulitis: treatment

The Diverticulitis Therapy Depends on which discomfort the person has and which structures are inflamed in the abdomen. Uncomplicated diverticulitis can be dealt with acutely with measures such as fasting and liquid diet, long-term with a fiber-rich diet and regular, physical exercise under control. Similarly, in diverticulitis, antibiotics (for example, metronidazole and ciprofloxacin) or anti-inflammatory agents such as aminosalicylates may be used. Anticonvulsant drugs such as metamizole and butylscopolamine can help with diverticulitis treatment.

Patients with diverticulitis who have severe pain or fever should be hospitalized in the hospital be treated. In many cases they are not allowed to eat. Instead, they get infusions and antibiotics. Often the diverticulitis therapy succeeds even without surgery. If the symptoms improve, you start to eat after about two to three days.

In cases of severe diverticulitis or complications, such as intestinal perforation (breakthrough of the bowel wall), surgeons recommend removing the damaged bowel. In the case of bowel perforation, surgery must be done as soon as possible. In other cases, doctors plan surgery only after the inflammation has subsided, about six to eight weeks after the start of antibiotic therapy. However, the operation may also take place sooner if the symptoms do not disappear despite antibiotic infusions.

If an abscess (pus accumulation) has formed in the abdomen, it will be punctured with a needle and the pus drained as part of the diverticulitis therapy, depending on where exactly it lies.

If one or more diverticulae have burst, the affected piece of intestine must be removed as soon as possible. Otherwise there is a high risk that the entire peritoneum inflamed (peritonitis). The peritoneum is a thin skin that lines the abdominal cavity from the inside.

Recurrent (chronic recurrent) diverticulitis should also be operated on.

Course of diverticulitis surgery

During surgery, the intestinal section is removed with the diverticula and the remaining intestinal ends sewn together again.

For diverticulitis surgery is a laparotomy required. In some clinics, surgeons remove the diseased bowel as part of a laparoscopy. In this so-called laparoscopic-assisted technique Nevertheless, a small abdominal incision is needed – unlike a purely laparoscopic surgery, such as a gall bladder removal. If diverticulitis has occurred during diverticulitis, this definitely requires open surgery.

In an emergency or a particularly serious inflammation sometimes an artificial bowel (anus praeter) is applied to temporarily relieve the intestinal suture. The artificial exit is usually relocated a short time later in a second operation. Sometimes the normal intestinal transit can not be restored. The intestine then ends at a hole on the skin. The chair gets into a pouch that is attached to the skin.

Complications of diverticulitis surgery

In about one percent of cases complications occur in diverticulitis surgery. For example, the new connection of the intestinal sections does not hold (anastomotic leakage) and it accumulates pus in the abdominal cavity (abscess). It is also possible that the surgical wound heals only delayed (wound healing disorder), or that later a break in the scar arises (incisional hernia). If diverticulitis requires emergency surgery, the risk of complications is much higher.

Tips against relapse

In 30 percent of patients, diverticulitis recurs after a while (relapse). However, the risk decreases when patients eat high-fiber diets, drink a lot (at least 2 to 2.5 liters a day) and avoid constipation.

Physical exercise also gets the intestines going. The sport is easier and more fun when you lose extra pounds. After a diverticulitis operation, you should not lift heavy loads (over ten kilograms) for about four to six weeks so that there is no scarring.

Diverticulitis: prevention

Why diverticula form in some people is not clear. A general connective tissue weakness, constipation and constipation seem to favor the outpourings of the intestinal wall and thus diverticulitis.

A healthy lifestyle prevents diverticula and the associated diverticulitis and reduces the risk of inflammation. With a few simple measures, keep your digestion going:

• Move Do it regularly, preferably two to three times a week, at least half an hour. Operate e.g. Endurance sports such as jogging or swimming.
• Drink It is sufficient (at least two liters a day), preferably mineral water or herbal tea.
• Nourish yourself high fiber with fruits, vegetables and whole grains, but less sugar and white flour products.

So you can protect yourself from diverticulitis with a few small lifestyle changes.

Diverticulitis: diet

How to eat properly, if you have a diverticulitis or you want to prevent, read in the article diverticulitis – nutrition.

Diverticulitis: disease course and prognosis

When inflamed diverticula break up (perforate) in diverticulitis, circumscribed buildup of abscesses (abscesses) may form in the abdomen. Diverticulitis can also spread to the peritoneum (peritonitis). Bleeding occurs in about five percent of patients with diverticulitis.

In addition, diverticulitis can be used to compress a section of the intestine so that its interior narrows (stenosis). If the intestinal contents are no longer transported through this bottleneck, intestinal obstruction (ileus) develops.

In the context of diverticulitis, it is also possible to develop connecting ducts between different sections of the intestine, intestine and bladder, or intestine and vagina. These so-called fistulas are very uncomfortable and often expensive to treat.

After a first diverticulitis, the risk of recurrence is 30 percent. The earlier in life one diverticulitis The more likely she or she will eventually be treated by surgery.